Key result
Higher asleep systolic BP in OSA links to ~37% higher risk of composite CV events.
Why the study?
Obstructive sleep apnea causes increased sleep systemic systolic blood pressure and elevated cardiovascular risk.
Does sleep systolic blood pressure mean and relative decline predict adverse cardiovascular events in hypertensive patients with obstructive sleep apnea?
Cohort (n=34,536)
Does sleep systolic blood pressure mean and relative decline predict adverse cardiovascular events in hypertensive patients with obstructive sleep apnea?
In hypertensive patients with obstructive sleep apnea, asleep systolic blood pressure mean and sleep-time relative decline are the strongest blood pressure predictors of major cardiovascular events, outperforming office blood pressure.
OSA associated with higher CV event rates; leaves open whether screening or treatment alters outcomes.
Background: Obstructive sleep apnea (OSA) causes increased sleep systemic systolic blood pressure (SBP) and cardiovascular (CV) risk. Methods: This secondary analysis encompassed data of 2,065 Spanish polysomnography-confirmed OSA hypertensives (61±11.9 years, 79.5% male) and 32,471 Spanish non-OSA hypertensives (60.2±14.0 years, 51% male) from the Hygia Project. Annually throughout the 5.1-year median follow-up, they underwent comprehensive clinical evaluation and 48-h ambulatory blood pressure (BP) monitoring, with bed and wake-up times diary-recorded to calculate individualized awake and sleep BP means and sleep-time relative declines. Results: OSA subjects experienced higher CV event rates (p<0.001), including a 1.79-fold higher rate of the primary composite study outcome: myocardial infarction, surgical coronary revascularization, heart failure, stroke, and CV death. Cox survival analyses revealed the baseline asleep SBP mean most strongly predicted the primary composite study outcome [HRadjusted =1.37 (1.23, 1.52); p<0.001], while baseline enhanced sleep-time relative SBP decline most strongly predicted protection against it (HRadjusted=0.75 (0.67, 0.83); p<0.001]. Furthermore, when the Cox statistical model included adjustment for the sleep SBP mean, office BP was not predictive of risk. Conclusion: The sleep SBP mean and decline were the BP parameters most predictive of CV events in OSA subjects, constituting major targets of clinical management.
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Castriotta et al. (2026) conducted a cohort in Hypertension and Obstructive Sleep Apnea (n=34,536). Baseline asleep systolic blood pressure mean in obstructive sleep apnea vs. Non-OSA hypertensives / lower asleep SBP was evaluated on Composite of myocardial infarction, surgical coronary revascularization, heart failure, stroke, and cardiovascular death (HR 1.37, 95% CI 1.23-1.52, p=<0.001). Baseline asleep systolic BP mean in OSA hypertensives strongly predicted composite CV events (adjusted HR 1.37; 95% CI 1.23-1.52; p<0.001), whereas sleep-time SBP decline was protective (HR 0.75).
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